Global Nephrology: Opt Out Gains Ground in the UK

The Leading Article published in the Independent newspaper in the UK demonstrates how public opinion is shifting as the organ shortage grows.

"Each year in the UK, between 500 and 1,000 people die from kidney failure because of a shortage of organs for transplant. We have tolerated this avoidable loss of life for decades.

The measure likely to have the biggest impact, however, would be to replace Britain's "opt-in" policy – which requires individuals to signal their willingness by joining the National Donor Register – with an "opt-out" policy that assumes all are donors unless they specify to the contrary.

The proposal was rejected by the Government in 2008 on the grounds that an opt-out system was paternalistic, ran counter to the emphasis on choice, and could even damage the trust between patients and doctors. We disagree. Rather, it would establish a culture where donation is simply normal – which is as it should be. And thousands of lives would be saved."

The British Medical Association (BMA) in a recent report also supports an opt-out system, writing: " the introduction of an "opt-out" or presumed consent system for organ donation, with appropriate safeguards, would transform people's lives".

The number of patients on the active kidney waiting list and the number of
patients who have had kidney transplants (cadaveric and live) in the UK
(Source: UKTSSA, BMA 2008)

The topic has also been actively debated in Northern Ireland and in Wales. In a recent survey in Wales, over 2/3rds supported the idea of an opt-out system in Wales.

The most lucid explanation of why action is needed was made over 10 years ago by the BMA: 

"The Government's response to-date has been piece-meal with a series of reviews recommending minor changes to the existing system. This 'tinkering at the edges' will not and cannot solve the problems. A radical review of the whole system is urgently needed. Building on experience in the UK and other countries, we must develop a modern, efficient and effective service for the twenty-first century. The BMA recognises the dedication of those working within the transplant service and the difficulties they face because of the severe shortage of organ donors and pressures on the system. The responsibility for addressing these problems does not rest solely with the transplant community but is a matter for society as a whole." 

Yes that was over 10 years ago!